Provider Demographics
NPI:1083612048
Name:NORTH PENN THERAPEUTICS AND PHYSICAL THERAPY, INC
Entity Type:Organization
Organization Name:NORTH PENN THERAPEUTICS AND PHYSICAL THERAPY, INC
Other - Org Name:CORRY WORKS PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:R
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:814-664-9346
Mailing Address - Street 1:512 E COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:CORRY
Mailing Address - State:PA
Mailing Address - Zip Code:16407-9014
Mailing Address - Country:US
Mailing Address - Phone:814-664-9346
Mailing Address - Fax:814-663-0169
Practice Address - Street 1:512 E COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:CORRY
Practice Address - State:PA
Practice Address - Zip Code:16407-9014
Practice Address - Country:US
Practice Address - Phone:814-664-9346
Practice Address - Fax:814-663-0169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-13
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT009652L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA457211OtherBLUE SHIELD PROVIDER NUMB
PA396570Medicare ID - Type UnspecifiedPROVIDER NUMBER